What’s Next For Egg Freezing?
A look at an industry at the cross-section of science and societal trends
A few years ago I read an article titled Why Egg Freezing is an Impossible Choice. The concept of women freezing their eggs (more formally known as Oocyte Cryopreservation) was not foreign to me, but it was the first time in years I had read about the process as well as any technological progress that had been made. (It turns out, it was in 2012 when the American Society for Reproductive Medicine no longer called the procedure “experimental.”)
As someone who believes in science’s ability to push how we as humans evolve, the so-called biological clock continues to function more similarly to our ancestors’ and hasn’t evolved with societal changes. This pushed me to want to understand how others were tackling emerging problems in reproductive medicine and fertility. In our ever-evolving social climate, family continues to be a core pillar of humankind. Thus this sensitive intersection of family and healthcare is incredibly important to myself and many others.
A lot of progress has been made since the formerly mentioned article was published in 2015. Here are the facts on egg freezing today:
- Women are born with a finite number of eggs
- The genetic normality of those eggs declines over time.
- Which means the risk of genetically abnormal pregnancy increases from an average of 1 in 475 at the age of 25 — to 1 in 18 at the age of 45.
All data found here
The key takeaway from these facts is to show what I previously mentioned: While a variety of factors has pushed childbirth later into people’s lives, evolution has not kept pace. And while routes such as adoption continue to be a very viable option, there are reasons to believe that women will increasingly rely on egg freezing.
By 2018, the Society for Assisted Reproductive Technology (SART) estimates that 76,000 women will freeze their eggs — more than 15 times the rate in 2013.
While the total number of people actually freezing their eggs is relatively low today, many positive catalysts are there.
- The freezing process of Vitrification (a fast-freeze method) has proven to be much more successful than previous methods with 90–95% of eggs frozen using vitrification surviving the freezing and thawing process (compared to just 61% of slow-frozen eggs).
- Companies like Facebook and Apple have (somewhat controversially) offered it as a perk.
- Our changing social climate is driving elective procedure growth. Previously egg freezing was mostly pursued by women who were undergoing some form of chemotherapy, surgery, or radiation therapy. Today it is increasingly also being considered for elective reasons. An anonymous survey conducted to better understand women’s beliefs, priorities, and attitudes toward egg freezing showed that 88% of the respondents cited lack of partner, while 24% cited professional reasons, and 15% financial reasons. Keep in mind that this is just one survey. I believe that the biggest obstacle we face when discussing egg freezing is the tendency to make sweeping generalizations about the lifestyle choices of a “21st century woman”, so please take this as a single data point.
However, there are also some negative or at least neutral catalysts including:
- Egg freezing is not an insurance policy to guarantee childbirth in the future (but it is increasingly being marketed as such). The data shows that that egg freezing does not mean a 100% chance of a successful live birth, even if done during the prime ages of fertility. The chart below comes from a study done by Human Reproduction and predicts that women 35 or under who freeze 10 eggs have a ~70% chance of at least one live birth later on and if they increase to 20 eggs, their chances jump to 90%. What the report doesn’t disclose is that going from 10 to 20 eggs also means undergoing a second egg retrieval procedure which is highly-invasive and expensive.
- There isn’t a ton of meaningful data around the completion of the process. Per TIME “Of the 353 egg-thaw cycles in 2012, only 83 resulted in a live birth. After 414 thaws in 2013, 99 babies were born. Those are the most comprehensive live-birth rates for egg freezing, and they’re just under 24%. (It should be noted that some of these eggs may have been frozen with an older slow-freeze method, which has a much lower success rate.)”
- It is still very expensive (but the costs are coming down). There are numerous scattered data points surrounding this which the graphic to the left claims to have tried to normalize. The two main things to note here are 1) the annual fee for storage and 2) that to get the percentages that many are promised, often women need two egg collection attempts (as mentioned above) which can cost ~$5-$10k each time. Some new companies are doing creative things around the financing component which also has lowered the cost barrier for the entire process.
So what was I talking about again?
The barriers for widespread availability of egg freezing come down to education, costs, and social stigma. In 2015, I felt like there could be different ways to consolidate demand in cities, outsource the technology and infrastructure costs related to the storage of eggs (in hopes of lowering price) and provide a better experience at scale (including education). Essentially, build a strong brand around transparency, operational efficiency, and customer experience.
I briefly outlined this when I first published a document that year.
Hardly mind-blowing stuff, I know.
Today, I still believe opportunities could lie somewhere on the range of an abstracted layer on top of a medical facility (like what Simple did for banking) with no physical infrastructure, or even a full brick and mortar brand and facility. The companies attacking this include Prelude Fertility and Extend Fertility. Both offer a seemingly improved user-experience as well as new financing techniques, but still cost more than 60%+ of Americans have in their savings account up front.
Progyny has gone a step back from the full-stack approach with a financing + marketplace model with other startups also trying to take new approaches to tackling the financing dynamics at play(hefty upfront + recurring payments). The biggest issue I have seen in some of these debt-like financing plans is that these eggs are treated as tangible assets (and there is a secondary market for them) thus you run into the moral implications of “re-possessing” someone else’s eggs, which doesn’t sit well with many.
And while I am intrigued by the possibilities of “consumerized hospital” plays like One Medical, recent failures when targeting niches (such as Leo Health) could point to an underlying business model flaw that often plagues the complex world of healthcare. With that said, the lower-resistance approach could very well begin with better data, personalization, tracking, or a lower-touch user experience.
Some companies that sit in this part of the stack include Clue, Glow, and tangentially Maven Clinic in addition to a variety of precision medicine or gene-related companies like Counsyl and Celmatix or the now acquired Recombine and Verinata Health. They all have pushed into this space by providing data, consultation, and/or a better user experience for women’s healthcare, whether on a daily basis or on either end of the fertility process.
There are great companies that are solving these problems, but despite the incredible progress made, I still believe there are many opportunities left.
There’s a better brand to be built, other wedges to help solve this problem, and/or new models that can exist to help solve any of the problems ranging from education to financing to precision medicine. If you feel like you know someone (or ARE someone) working on these problems, then I’d love to learn more.
If you’re looking for more data or resources on egg freezing here are some links to sift through:
The Egg Freezing and Embryo Banking Program at the NYU Langone Fertility Center helps preserve fertility. Learn more.nyulangone.org
Hum Reprod. 2010 Sep;25(9):2239-46. doi: 10.1093/humrep/deq146. Epub 2010 Jun 30. Randomized Controlled Trialwww.ncbi.nlm.nih.gov
Egg Freezing Success Estimator Based on the Number of Eggs Frozen (Thawed)Freezing Method Vitrification Slow Freezing…fertilitypreservation.org
When Jo Dhesi froze her eggs in early February she chose to avoid the typical fertility clinic. Instead, the newly…nymag.com
Egg freezing has been hailed as a game-changer for women, an "insurance policy" to revitalize waning fertility, a…time.com
Women must be fully informed about reproductive medicine before setting their hopes on it. Facebook and Apple and all…www.wired.com
Egg freezing, 1 year on. A little over 1 year ago I was bed ridden yet again, not from Endo directly but the threat of…sylfreedman.com
Egg Freezing and the Biological Clock — Extend Fertility